Mid-Term Results of EVAR in Severe Proximal Aneurysm Neck Angulation

Objective To determine if mid-term outcome following endovascular aneurysm repair (EVAR) with the Endurant Stent Graft (Medtronic, Santa Rosa, CA, USA) is influenced by severe proximal neck angulation. Methods A retrospective case–control study was performed using data from a prospective multicenter database. All measurements were obtained using dedicated reconstruction software and center-lumen line reconstruction. Patients with neck length >15 mm, infrarenal angle (β) >75°, and/or suprarenal angle (α) >60°, or neck length >10 mm with β >60°, and/or α >45° were compared with a matched control group. Primary endpoint was primary clinical success. Secondary endpoints were freedom from rupture, type 1A endoleak, stent fractures, freedom from neck-related reinterventions, and aneurysm-related adverse events. Morphological neck variation over time was also assessed. Results Forty-five patients were included in the study group and were compared with a matched control group with 65 patients. Median follow-up time was 49.5 months (range 30.5–58.4). The 4-year primary clinical success estimates were 83% and 80% for the angulated and nonangulated groups ( p = .42). Proximal neck angulation did not affect primary clinical success in a multivariate model (hazard ratio 1.56, 95% confidence interval 0.55–4.41). Groups did not differ significantly in regard to freedom from rupture ( p = .79), freedom from type 1A endoleak ( p = .79), freedom from neck-related adverse events ( p = .68), and neck-related reinterventions ( p = .68). Neck angle reduction was more pronounced in patients with severe proximal neck angulation (mean Δα −15.6°, mean Δβ −30.6°) than in the control group (mean Δα −0.39°, mean Δβ −5.9°) ( p